Wheelchair-bound
multiple sclerosis patient Richard Paey is serving 25 years in a Florida
prison for “trafficking” 1/2 gram of OxyContin, even though the prosecutor
concedes that Paey never sold any of his medications. In prison, he now
receives more pain-killing drugs than he was convicted of having.

Dr. William Hurwitz, a pioneering pain
physician, was tried and convicted of violating the Controlled Substances
Act -- which is intended to curb the illicit use of drugs -- and is
serving a 25-year term in federal prison. He was also fined $2 million.

These are but two of hundreds of cases in
which, in its zeal to stamp out the illegal drug use, the U.S. Drug
Enforcement Administration (DEA) is cracking down on doctors who prescribe
medications to relieve chronic pain, and the patients who depend on these
drugs to live normal lives.

Hundreds of physicians have been put on
trial for charges ranging from health insurance fraud to drug
distribution, even to manslaughter and murder for over-prescribing
prescription narcotics. Investigators have also seized doctors’ homes,
offices, and bank accounts, leaving them with no resources for their
defense.

In March 2004, DEA administrator Karen Tandy
told Congress her drug warriors have "been successful in addressing
OxyContin diversion as evidenced by a reduction in the rate of increase of
OxyContin prescriptions being written and a leveling-off of OxyContin
sales." But Ronald Libby, a professor of political science at the
University of North Florida, told us he doubts that sales of opioids like
Oxycodone have declined since 2004.

Drug diversion means the diversion of legal
drugs for illicit purposes. Prescription drug abuse accounts for almost
30% of the overall drug problem in the United States, representing a close
challenge to cocaine addiction. Sometimes these diverted prescription
drugs end up for sale on the street, where they reap large profits for
traffickers.

Starting in the mid-1990s, and ratcheting up
in 2001, the DEA -- part of the U.S. Department of Justice (DOJ) -- has
been leading an aggressive effort to eradicate the illegal "diversion" of
certain prescription painkillers. A particular target has been OxyContin,
one of a class of drugs known as opioids, which was aggressively marketed
by its manufacturer, Purdue Pharma.

In 2001, the DEA launched a campaign called
the "OxyContin Action Plan”. The DEA says the plan is necessary due to
increasing abuse of prescription drugs, particularly by youth. The agency,
which has teamed up with state and local authorities, typically employs
law enforcement methods developed in the government’s “War on Drugs”,
including aggressive undercover investigation, asset forfeiture, and
informers. It says its goal is to stop violations of the Controlled
Substances Law.

But critics charge that the DEA has focused
too narrowly on doctors, exacerbating the already widespread problem of
untreated or under-treated pain. As a result, well-meaning doctors are
finding themselves subject to costly, potentially career-ending
investigations. Several doctors and many of their patients have already
been sent to prison.

The DEA maintains that only “criminal
doctors” are being targeted, and that its efforts to prevent the sale of
prescribed medications have no effect on the legitimate treatment of pain.

The pain-management community disagrees.
Authorities say the DEA program reportedly is having a chilling effect on
physicians, who are leaving their pain management specialties for safer
practices, and on their patients, many of who literally cannot function
without medication. The Village Voice newspaper reports that
medical schools are now advising students to avoid pain management
practice altogether.

Ironically, the DEA crackdown comes at a
time when the medical profession knows more than ever about how to treat
the chronic pain that makes life intolerable -- sometimes impossible --
for the estimated 50 to 70 million Americans who live in chronic disabling
pain.

Until about 20 years ago, the medical
profession knew little about pain management. Today, pain management has
become a recognized medical specialty, and it is estimated that there are
some 5,000 pain management doctors practicing in the U.S.

The DEA’s programs also come at a time when
there are more effective pain-killing drugs on the market and when the
Internet makes it easier than ever to obtain them.

The DEA’s dilemma is separating legitimate
prescribers and users from drug dealers. And the DEA’s task is made more
difficult, not only by its zeal, but by the fact that those investigating
and prosecuting are not doctors but lawyers and law enforcement agents.

Before he was ever charged with a crime, Dr.
Hurwitz recommended that the DEA “suspend current prosecutions against
physicians who treat pain unless and until a review by a panel of
nationally recognized experts in medical pain management has found that
there is an absence of good faith by the physician. If only the
physician's adherence to standards of care can be questioned, then the
case is not an appropriate one for the criminal process, and should be
referred to the professional regulatory authorities,” he said.

The Association of American Physicians and
Surgeons, in a letter to the judge in the Hurwitz case, charged he was
convicted on the basis of “false expert testimony”, which it described as
“egregious.”

Their letter said, “That a tiny percentage
of his patients then broke the law with their prescriptions does not
justify imprisoning Dr. Hurwitz for the rest of his life. A conviction
based on this false medical testimony should not stand….”

The Hurwitz situation is not isolated.
Throughout the U.S., physicians have been prosecuted, jailed, or have lost
their licenses to practice medicine. In addition to Hurwitz, Dr. Ronald
McIver is serving 30 years, Dr. Freddie Williams is serving life, and Dr.
James Graves received a 62-plus-year sentence for diversion in 2002.

According to Prof. Libby, who has become an
authority on the subject, “Many doctors have been convicted and almost no
one has been acquitted.” He told us, “Most attorneys tell their clients to
cop a plea and not fight it in court.”

Richard Paey was convicted of fraudulently
submitting multiple copies of opioid prescriptions to treat chronic pain.
He was in New Jersey where his doctor treated him, but then moved to
Florida where he was unable to find a physician to write prescriptions to
treat his pain.

Frightened by what they term a “brutal
display of executive power”, most doctors, including those in the field of
pain management, have simply abandoned this sickest and most vulnerable
segment of our population. Patients suffering from mild to moderate pain,
and requiring low dosages of opioids may still find care, but those
patients with high dosage requirements are increasingly shut out of care
altogether.

In 2004 it was estimated that many of the
5,000 pain specialists in the United States, would not prescribe opioids.
Those few medical practices that do treat chronic pain with opioids impose
severe restrictions on patients’ freedoms. Prof. Libby told us that many
doctors are now prescribing over-the-counter medications such as aspirin
and Tylenol, “which are far more dangerous than opioids if taken in large
quantities.”

The DEA claims it investigates less than one
per cent of physicians who prescribe OxyContin or other drugs covered by
the Controlled Substances Act. The agency reported arresting 34 doctors
out of 963,385 registered doctors in 2003, for selling opioids to addicts
or drug dealers for money, sex, or favors. That is less than 0.001% of the
total number of licensed doctors, the DEA said.

But critics dispute that figure. Prof. Libby
told us, “In 2001, the DEA carried 861 investigations of doctors. If we
use this figure instead of 34 arrests it means that more than 17 percent
of the roughly 5,000 doctors who treat pain patients were investigated.
That means that than one out of every six doctors who treat chronic pain
patients were under criminal investigation.”

A not-for-profit advocacy group, the Pain
Relief Network, is suing to have the Controlled Substances Act declared
unconstitutional, and is seeking to enjoin the DEA from enforcing the law
against physicians.

To calm its critics, the DEA commissioned
several pain specialists to work with Federal officials to create
guidelines for physicians who treat pain with opioids. These guidelines
were posted on the agency's website, and most doctors were led to believe
that following the recommendations would keep them safe from prosecution.

But that understanding didn't last long.
Late last year the guidelines were taken off the DEA's website. The agency
claimed it wasn't bound by any standards or practices when it came to
determining what physicians it would investigate.

Removal of the guidelines coincided with Dr.
Hurwitz’s trial. The doctor’s attorneys attempted to have the guidelines
admitted as evidence on the belief that Hurwitz's practice conformed to
their parameters. They failed. A few weeks after Hurwitz's judge refused
to admit the guidelines as evidence, the DEA renounced them, and
essentially declared it had carte blanche to launch an inquiry.

David Jorenson, the academic pain specialist
who headed the committee that authored the original guidelines, sent the
agency a sharply-worded rebuke. Three other professional associations
representing pain specialists followed with a second letter. And the
National Association of state Attorneys General wrote to the DEA,
expressing concern that the agency was overstepping its bounds and
interfering with the legitimate treatment of pain. The letter was signed
by 30 AGs from both parties.

However, the DEA remains unmoved, insisting
its revocation of the guidelines did not represent a shift in policy and
that its pursuit of doctors should have no effect on legitimate pain
treatment.

Dr. Alexander DeLuca, MPH, a member of the
American Academy of Preventive Health and a Policy Analyst and Board
Member of the Pain Relief Network, told us, ”Relations between physicians
and the DEA have probably never been worse in modern times.”

He added, “Law enforcement does not deserve
a place at the table where physicians, social workers, and politicians of
good will need to meet to deal with drug use and pain problems as public
health, not criminal, matters.”

William Fisher writes for Inter Press News Service.
He has managed economic development programs in the Middle East and
elsewhere for the US State Department and the US Agency for International
Development. He served in the international affairs area during the
Kennedy Administration.